Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Clin J Am Soc Nephrol. 2014 Aug 7;9(8):1369-76. doi: 10.2215/CJN.06700613. Epub 2014 Jun 12.

Left atrial volume and adverse cardiovascular outcomes in unselected patients with and without CKD.

Author information

  • 1Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
  • 2Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia;
  • 3South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia; and.
  • 4South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia;
  • 5Cardiology Department, Liverpool Hospital, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Western Clinical School, University of Sydney, Sydney, New South Wales, Australia l.thomas@unsw.edu.au.

Abstract

BACKGROUND AND OBJECTIVES:

Patients with CKD have increased cardiovascular morbidity and mortality. This study investigated the prognostic value of common clinical echocardiographic parameters.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

There were 289 unselected consecutive patients who had a transthoracic echocardiogram between January and June 2003. Patients with stage 3 or 4 CKD (n=49) were compared with those with eGFR≥60 ml/min per 1.73 m(2), n=240). Left ventricular volume, ejection fraction and mass, left atrial volume, and function parameters were measured. The primary endpoint, determined a priori, was a composite of cardiac death, myocardial infarction, and congestive cardiac failure.

RESULTS:

Patients were followed for a median 5.6 years. The incidence of the primary endpoint was higher in patients with CKD (29% versus 12%, P=0.001), who were older and had a higher prevalence of hypertension and ischemic heart disease. Indexed left ventricular mass (LVMI) and left atrial volume (LAVI) were higher in patients with CKD. Furthermore, patients with LAVI>32 ml/m(2) had significantly lower event-free survival than patients with normal (<28 ml/m(2)) or mildly dilated LAVI (28-32 ml/m(2)) (P<0.001). Multivariate analysis showed that age (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.08 to 1.31; P=0.001) and LVMI (OR, 3.66; 95% CI, 2.47 to 5.41; P<0.001) were independently associated with LAVI>32 ml/m(2). Multivariate Cox regression analysis demonstrated that CKD (hazard ratio [HR], 1.13; 95% CI, 1.01 to 1.26; P=0.04), hypertension (HR, 2.18; 95% CI, 1.05 to 4.54; P=0.04), and a larger LAVI (HR, 1.35; 95% CI, 1.02 to 1.77; P=0.04) were independent predictors of the primary endpoint.

CONCLUSIONS:

Patients with CKD were at higher risk for cardiovascular events. LAVI was significantly larger in the CKD group and was a predictor of adverse cardiac events.

Copyright © 2014 by the American Society of Nephrology.

KEYWORDS:

CKD; cardiovascular disease; congestive heart failure; echocardiography; left ventricular hypertrophy

PMID:
24923578
[PubMed - in process]
PMCID:
PMC4123395
[Available on 2015/8/7]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire
    Loading ...
    Write to the Help Desk